Cosmetic Surgery Videos
|Length of video||7:43|
By Dr. Ricardo L Rodriguez
Stretched and "Done" vs. Natural and Young
When patient's come in talking about a facelift, they generally want to look younger and point out the things that they don't like about their faces . . . but when you stretch your facial skin back, it results in a "pulled" look, with the corners of the mouth also stretching back.
I have been in practice for over 20 years and have seen a lot of facelift results that I was less than impressed with. To me, the best facelift results in a more youthful, refreshed appearance, as opposed to the 'done' look.
In this video I discuss the factors which result in the best facelift outcomes. I use before and after photos to illustrate the "stretched" look, a computer diagram showing eye-tracking movements of people viewing a face, and a recent facelift patient's before and after photos to show you a more natural facelift result.
While most people tend to be concerned about the jaw line and jowls, the lower face is actually the area that others see the least. So instead of focusing on how you see yourself, I like to focus on how others see you, how others look at you. I approach a facelift from top to bottom, focusing on the eyes and the mid-face first, not only from a perception point of view, but also from a functional and structural point of view.
There are various types of facelifts and techiniques to discuss during a consult, but the best facelift results in a more youthful, refreshed appearance with relaxed eyes and a sense of volume underneath the eyes and in the cheek area as opposed to the 'done' or 'stretched' look where the corners of the mouth tend to pull upward and the ears tend to pull forward. A good facelift should be a restructuring of the face, not a pulling of the skin.
Hi, I'm dr. Ricardo Rodriguez and today I want to talk to you about the different types of facelifts.
This is a picture I got, you know, when I was starting out in practice, I didn't have that many cases and there are companies that specialize in giving you pictures of patients to just sort of show patients what can be done.
And this is a typical facelift, but what I want you to notice is, you know, the woman has her jowls in here and she has been stretched down; but, she's very stretched down below. Now they obviously consider that a desirable result, but I can tell you that in my mind, somebody that stretched looks, well, you know, done. And you have seen many of those people around. Now, why does that happen? Nobody starts out trying to make a patient stretched.
What happens is the patient comes to your office and she says, you know, quite reasonably, "Doc, you know, I want to look younger and I'm looking in the mirror and I don't like this, or could you please do this." And they do that, and it looks fine. But, you know, the one thing I want you to notice, first thing, is when you do this, look, the corners of your mouth can get stretched, okay?
And that is something that I typically see with what they call the lower facelift. It's that the lower part of the face, since it's what gets stretched, you know, this gets stretched.
Now, let me give you a different viewpoint. Okay, this picture is of a famous, you know, silent film era actress, and they posted this picture on a computer screen and behind the computer screen there was a little camera and the camera tracked the eye movements or the person looking at the picture.
Therefore, what you're seeing here is that eye movement going like this - boom, boom, boom - and then, you know, they go down to the nose a little bit and down to the mouth and then really, down in here, the area that the patient is most concerned about, the jawline and the jowls, just a once-over. Okay? And that is a profound difference in perception because what you perceive in yourself to be what's aging is different from what other people perceive.
The reason for this is that when other people look at you, they look at you in the eyes, okay? I'm looking at you right now in the camera, to your eyes. and you're looking at my eyes, too! you don't care what my neck looks like, or whether I've got this little line in here, you're just sort of following what I say and if I were closer to you it would be even stronger. You'd try to hold my gaze to see, you know, catch my meaning or catch my drift.
Now, what if you focus your facelift on how other people perceive you or how other other people actually see you. Well, that is a different way of looking at facelifts and it's the way I look at a facelift, because when I want to make a person look younger, I want it to look younger to other people. I don't want them to look done, I want them to look younger.
Okay, so here's another patient on whom I just did a brow lift, so rejuvenating the area around the eyes and the mid-face. The mid face lift was rejuvenated with a little bit of injection of fat and a mid facelift. Now, look at the difference in this patient. She's not pulled, okay, the corners of her mouth aren't pulled, she just looks younger. You can't really tell, she just looks much better.
Her face looks much sadder (pointing to the before photo), she looks much more relaxed (pointing to the after photo), and there's a sense of volume in here underneath the eyes that's very important.
Now, as you look at her, you know, for projections, you will see that there is this line in here which Dr. Bill Little from DC described as an OG line, and it's a nice curve in here indicating volume on the cheek. And that's why I like the three-quarter shot when I do post-op shots of my patients, but you know, in here she's very flat and that corresponds to a widening out of the face as the tissues fall down, the face tends to get more square and, you know, as you're looking at me right now you're probably saying "Oh, you know, there goes Dr. Rodrigeuz, his face is getting wide in here" . . . well, maybe someday I'll get a facelift, but; for now, look at her, you know, she's getting the volume up in here. She looks much younger. The results are really outstanding.
Now, do you have to wait a long time to do that? No, look at this woman, I mean, she was relatively young, she was in her early 40s. Does she look like she needed a face lift? No! But she obviously benefited from this. and again okay notice - just the eyes look more relaxed, the volume on the cheeks, the OG curve, she just looks much better.
Now, you know, no scar in here because we haven't touched that. All we did was a brow lift okay and the mid facelift.
Another thing I don't like about the lower facelift is that when people pull back in here, and say okay, you know, the skin is actually gonna stick in here. Well, no, you know, that doesn't happen.
There's a play of forces between the skin you have pulled and the existing structures. So one thing you see in a lot of patients who have had a facelift is, you know, the ear comes forward like this and appears to come along, and it's because you pull this skin and sure, a lot of it will stay back, but there will be some relaxation and some pulling on the ear forward. Okay, so generally, I like to approach my facelift from top to bottom and as a matter of fact the last thing I will do with the least amount of pull is the lower half of the face.
Now, the effect is dramatic. It's even seen on younger people who don't have like all the wrinkles and the fallen face or anything like that. For example, this patient, okay, she's already beginning to get a little bit of the jowling but look, not a wrinkle in her face. I mean, nobody would say, "oh, she needs a facelift" and the truth is, she doesn't. she just wanted to look better. Okay but look at the big volume gain in here, especially on a young patient, okay, and you know overall just a restructuring of the face - so on her it's not so much that her face looks younger, it's that her face has been restructured to a better shape and all of that with very modified limited techniques.
Now, I think that focusing from the eyes first and the mid-face first is a more rational approach. After all, it is the approach we use when we do facial fractures. We start from the top, from the solid base, and we work our way down. And that's the way I approach my things now, from a perception point of view as far as, you know, how I look at the patient and how other people see the patient, but also from a functional and structural point of view.
I want to get my solid anchoring face on the top first so that by the time I get to the bottom I don't have to pull as much, I don't get that pulled look.
Anyways, if you have any questions just write them on the blog post like you always do I'm happy to hear from you guys. If you have any suggestions, please write them to me. Anyways, thanks for listening and I'll be posting again soon.